06/17/08
WASHINGTON – Just when doctors thought things couldn’t get much worse, experts say, the Centers for Medicare & Medicaid Services has thrown another wrench into the already difficult transition to using National Provider Identifiers.

According to a June 11 CMS announcement, doctors will have to reconcile their NPI data with their IRS legal name data in order to get paid.

I read to there, and thought, ‘well, that’s not entirely unreasonable’. What an idiot I am.

According to billing experts, this is a disaster waiting to happen. Every aspect of the data must match, including the exact spelling of names, the use of initials and even blank spaces in the data. The slightest discrepancy could send Medicare claims back to the drawing board.

Aah. So, Medicare issues a NPI, which isn’t checked against the IRS name, then retroactively and apparently without notice announces they’re not going to pay for work already done in good faith, over yet another clerical gotcha, in which they were complicit. Breathtaking, the hubris.

After a year-long contingency period, the use of NPIs was required by CMS as of May 23. Both before and since that deadline, doctors have had difficulty getting paid due to a host of complications with CMS and clearinghouse systems, experts say.

Cyndee Weston, executive director of the American Medical Billing Association, said the IRS matching requirement “has blindsided the whole industry.”

I might actually join the AMA if they said ‘no more’ to this crap. Unfortunately, I suspect they’ll hold their hat in their hands, appoint a commission, and say pretty please.